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PATIENT AGREEMENT
ROGUE DIRECT PRIMARY CARE, LLC
This is an Agreement entered into on, 20, between Rogue Direct
Primary Care, an Oregon Limited Liability Company (Clinic, Us or We), and
(Patient or
We are not affiliated with any brand or entity on this form
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Who needs rogue direct primary care?
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It is suitable for those who value personalized care, direct access to their doctor, and unhurried appointments.
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Additionally, individuals who want a comprehensive and preventive approach to healthcare, including routine check-ups, management of chronic conditions, and acute illness care, can benefit from rogue direct primary care.
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Overall, anyone who seeks a patient-centered and affordable alternative to traditional primary care may consider rogue direct primary care.
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What is rogue direct primary care?
Rogue direct primary care is a type of healthcare model where patients pay a direct fee to a primary care physician for services outside of insurance coverage.
Who is required to file rogue direct primary care?
Any primary care physician operating under the rogue direct primary care model is required to file.
How to fill out rogue direct primary care?
Rogue direct primary care can be filled out by providing details of services offered, fees charged, and patient information.
What is the purpose of rogue direct primary care?
The purpose of rogue direct primary care is to provide affordable and accessible healthcare services outside of the traditional insurance model.
What information must be reported on rogue direct primary care?
Information such as services provided, fees charged, patient demographics, and any other relevant details must be reported.
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